Virginia Supreme Court Limits Tolling Under Continuing Treatment Rule
Cothran v. Jauregui, Record No. 250019 (Va. Dec. 30, 2025)
In this opinion, the Supreme Court of Virginia clarifies the scope of the continuing treatment rule in medical malpractice cases.
Renee Jauregui saw Dr. Shannon Cothran, an OB/GYN, for several pregnancy-related visits between May and October 2018. According to Jauregui’s testimony, she informed Dr. Cothran of a breast lump during at least four appointments, and Dr. Cothran examined the lump and diagnosed it as a clogged milk duct that was a normal part of pregnancy. At Jauregui’s postpartum appointment in October 2018, Dr. Cothran allegedly assured her the lump would resolve with continued pumping and instructed her to monitor it and call the office if she noticed any changes. In July 2019, after noticing a change in the lump, Jauregui called and scheduled a follow-up appointment for August 2019, approximately ten months after her last visit. Subsequent diagnostic testing revealed that the lump was metastatic breast cancer.
Jauregui filed a medical malpractice complaint on June 30, 2021. Dr. Cothran filed a plea in bar based on the statute of limitations. The central issue was whether the continuing treatment rule applied to toll the two-year statute of limitations and allow Jauregui’s claims based on the 2018 appointments.
The trial court sustained Dr. Cothran’s plea in bar, ruling that there was no continuous and substantially uninterrupted course of examination and treatment. The court reasoned that no treatment was administered and that the ten-month gap, during which Jauregui was simply told to call if changes occurred, constituted a substantial interruption in the course of examination. The Court of Appeals reversed, holding that the trial court had misinterpreted the continuing treatment rule. The Court of Appeals found that because Jauregui returned pursuant to Dr. Cothran’s instructions for examination of the same condition, the course of examination was not substantially interrupted, regardless of Dr. Cothran’s expectations about whether Jauregui would return.
The Supreme Court, however, reversed the Court of Appeals and reinstated the trial court’s decision. In doing so, the Supreme Court clarified several important points about the continuing treatment rule. First, despite its name, the rule does not require actual treatment but rather a continuous and substantially uninterrupted course of examination or treatment, not necessarily both. Second, the Court distinguished between “continuous treatment,” which refers to the physician-patient relationship concerning the same illness or injury, and “substantially uninterrupted,” which adds a reasonableness component to the continuity requirement. The phrase “substantially uninterrupted” means the relationship must be mostly continuous, though not necessarily entirely so.
Applying this standard, the Supreme Court found that the trial court’s factual determination was supported by the evidence. After the October 2018 appointment, both parties proceeded as though the physician-patient relationship had ended, with neither forecasting any need for further examination or treatment. The ten-month interruption, during which the relationship was dormant with only the possibility of a future return, constituted a substantial interruption as a matter of fact. The Court emphasized that such determinations are fact-specific and entitled to deference when made by a trial court hearing evidence directly. Consequently, the trial court’s finding that was not “plainly wrong or without evidence to support it,” and malpractice claim based on the 2018 appointments was time-barred.